After a client and clinician have been exploring a topic, the clinician decides when the appropriate time is to offer a summary. 听In counseling, there is very little guidance in terms of what should go into a summary, and what should be left out. The clinician must make the decision about what to reflect back to the client and it will often include as much of the change talk offered by the client as possible. Again, providing a summary back to the client allows them to not only hear them describe their experiences but also encourages them to explore more. Summaries are different than reflections because summaries offer a number of thoughts or themes expressed by the client. As well, to hear something reflected back quickly is helpful, and to hear something reflected back over a period of time can be even more beneficial.
There is not one way to offer a summary and there may be times when the clinician focuses on different aspects of what the client has been sharing. For example, if the client is expressing a great deal of ambivalence about a particular topic, it may be important for the clinician to reflect back both the reasons for change and reasons to maintain the status quo. And other times, the clinician may focus more on the change talk in order to strategically move the conversation in this direction.
The summary offered by Miller and Rollnick below provides an example of a clinician reflecting back to a client much of the change talk expressed in their session:
鈥淪o here鈥檚 what you鈥檝e told me so far. Dr. Clark noticed a blood test elevated that often is a warning about drinking too much, and she was concerned enough to call you personally. That scared you a little. You were also surprised that there was still enough alcohol in your bloodstream for you to be arrested for drunk driving if you had been stopped, even though you had not had anything to drink in the morning. If that happened, you could lose your job. When you wake up in the morning you often feel pretty bad-headache, tired, nervous. That seems to happen more when the kids aren鈥檛 with you, and you drink more at night. What else have you noticed?鈥�
This example is MI consistent and focuses on the change talk being expressed by the client. Almost all of the change talk is reflected back to the client and none of the sustain talk. By focusing on the change talk, the client will likely continue to move in the direction of change and talk more about what needs to be different in their life. And by ending with an open question, this encourages the client to explore change even more. When a clinician offers a summary back to a client, it is often said that the clinician has been collecting individual flowers from the client and the clinician then shares it back to the client in the form of a bouquet. And again, if we reflect change talk back to the client, we are likely to hear more.
Summaries can be an extremely effective technique in working with a client. As mentioned earlier, there are not many guidelines for what to include in a summary. The clinician must decide what is most appropriate in a given situation. When asked about the best time to offer a summary, I usually say when there appears to be a good amount of change talk present, when I feel like we have explored this topic thoroughly, or when I believe the conversation is going astray and needs to be redirected back to the main topic. Next month, we will begin looking at how best to respond to sustain talk. I hope everyone is doing as well as possible and you have opportunities to use and practice Motivational Interviewing. Take good care!
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For more information about Motivational Interviewing or related services, contact Eunice Akinyi Okumu, by phone (919) 843-2532, or by email, eunice_okumu@med.unc.edu.